A pragmatic cluster randomized trial evaluating the impact of a community pharmacy intervention on statin adherence: rationale and design of the Community Pharmacy Assisting in Total Cardiovascular Health (CPATCH) study

<p>Abstract</p> <p>Background</p> <p>Traditional randomized controlled trials are considered the gold standard for evaluating the efficacy of a treatment. However, in adherence research, limitations to this study design exist, especially when evaluating real-world applicability of an intervention. Although adherence interventions by community pharmacists have been tested, problems with internal and external validity have limited the usefulness of these studies, and further well-designed and well-conducted research is needed. We aimed to determine the real-world effectiveness of a community pharmacy adherence intervention using a robust study design. This novel design integrates cluster randomization and an outcome evaluation of medication adherence using a population-based administrative data source in the province of Saskatchewan, Canada.</p> <p>Methods/Design</p> <p>Community pharmacies from across the province of Saskatchewan, Canada were randomized to deliver an adherence intervention to their patients or usual care. Intervention pharmacies were trained to employ a practical adherence strategy targeted at new users of statin medications. While randomization and implementation of the intervention occurred at the community pharmacy level, the outcome analysis will occur at the level of the individual subjects. The primary outcome is the mean statin adherence among all eligible new users of statin medications. Secondary outcomes include the proportion of new statin users who exhibit adherence ≥80%, and persistence with statin use.</p> <p>Discussion</p> <p>This novel study design was developed to combine the rigor of a randomized trial with a pragmatic approach to implementing and capturing the results in a real-world fashion. We believe this approach can serve as an example for future study designs evaluating practice-based adherence interventions.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov no. NCT00971412.</p

Behavioral sciences concepts in research on the prevention of violence

El propósito de este artículo es examinar los factores que pudieran explicar las variaciones de la violencia en el nivel poblacional e introducir conceptos de las ciencias conductuales en el campo de las investigaciones efectuadas por encuesta. La violencia y su prevención son temas que competen cada vez más a los especialistas de la salud pública. Conceptos propios de las ciencias del comportamiento se han aplicado al desarrollo de técnicas para prevenir diversas enfermedades mediante actividades de promoción de la salud, entre las cuales figuran el adiestramiento para la adquisición de destrezas, la persuasión, el uso de incentivos y los cambios ambientales de carácter facilitador. Este enfoque arraigado en la salud pública también puede aplicarse a la violencia. El análisis que parte de la salud pública puede ir más allá de las conductas individuales para enfocar las fuentes sociales y ambientales de la violencia individual y colectiva. Los factores ambientales pueden determinar la magnitud de los conflictos, así como los medios disponibles para resolverlos. Las actitudes, normas y habilidades pueden ejercer influencia en las decisiones individuales y colectivas sobre la manera de responder a situaciones capaces de suscitar violencia, y estos factores sociales y cognoscitivos pueden variar notablemente entre distintas culturas e incluso dentro de una misma. Si se desea llegar a un conocimiento más profundo de la violencia, las metodologías de entrevista propias de las ciencias sociales pueden aplicarse para medir variables cuantitativas, pero es necesario seleccionar estratégicamente los conceptos particulares que se han de evaluar. Estas variables pueden abarcar la aprobación de la sociedad, las actitudes valorativas, las normas e intenciones percibidas en relación con la violencia, las actitudes hacia opciones contrarias a la violencia, las habilidades y la autoeficacia que confieren, las interpretaciones de los conflictos y sucesos desencadenantes, el control de sí mismo y la capacidad para usar métodos no violentos para resolver los conflictos sociales. A fin de crear un enfoque de salud pública aplicable al control de la violencia en las Américas, la Organización Panamericana de la Salud organizó el proyecto ACTIVA, que es un programa multinacional de investigación colaborativa destinado a medir la victimización y los comportamientos agresivos y a identificar actitudes asociadas con los actos de violencia públicos y privados. Estos nuevos conocimientos podrían aplicarse a fin de aminorar la carga de violencia que enfrentarán las generaciones futuras en la Región de las Américas

Direct Outreach in Bars and Clubs to Enroll Cigarette Smokers in Mobile Cessation Services: Exploratory Study

BackgroundCigarette smoking and alcohol use are well known to be concomitant behaviors, but there is a lack of studies related to recruitment of smokers for mobile cessation services at places where alcohol is consumed, such as bars and clubs. Adapting recruitment strategies to expand the reach of cessation programs to where tobacco users are located may help decrease the health-equity gap in tobacco control by improving reach and enrollment of underserved smokers residing in low-income and rural areas who are not reached by traditional cessation services. ObjectiveThe purpose of this exploratory study was to assess the feasibility of direct outreach in bars, clubs, and restaurants to recruit smokers to Quitxt, our mobile smoking cessation service. Quitxt is delivered through SMS text messaging or Facebook Messenger. MethodsWe collaborated with an advertising agency to conduct in-person recruitment of young adult smokers aged 18-29 years, focusing on urban and rural Spanish-speaking Latino participants, as well as English-speaking rural White and African American participants. Street team members were recruited and trained in a 4-hour session, including a brief introduction to the public health impacts of cigarette smoking and the aims of the project. The street teams made direct, face-to-face contact with smokers in and near smoking areas at 25 bars, clubs, and other venues frequented by young smokers in urban San Antonio and nearby rural areas. ResultsThe 3923 interactions by the street teams produced 335 (8.5%) program enrollments. Most participants were English speakers with a mean age of 29.2 (SD 10.6) years and smoked a mean of 8.5 (SD 6.2) cigarettes per day. Among users who responded to questions on gender and ethnicity, 66% (70/106) were women and 56% (60/107) were Hispanic/Latino. Among users ready to make a quit attempt, 22% (17/77) reported 1 tobacco-free day and 16% (10/62) reported maintaining cessation to achieve 1 week without smoking. The response rate to later follow-up questions was low. ConclusionsDirect outreach in bars and clubs is a useful method for connecting young adult cigarette smokers with mobile cessation services. However, further research is needed to learn more about how mobile services can influence long-term smoking cessation among those recruited through direct outreach, as well as to test the use of incentives in obtaining more useful response rates

Moral disengagement and tolerance for health care inequality in Texas

Moral disengagement, Health disparity, Social inequality, Symbolic racism, Health policy, Texas,